Depression Resource Guide

Ann Arbor Police 911 ¥ Loss of interest or pleasure in Front Desk 994-2875 activities

U of M Department ¥ Change in weight or appetite of Public Safety (734) 763-1131 ¥ Difficulty sleeping or sleeping too much U of M Psychiatric Emergency Services ¥ Agitation and/or irritability (734) 996-4747 or (734) 936-6666 ¥ Recurrent thoughts of suicide Department of Psychiatry (734) 764-3471 ¥ Feelings of worthlessness or guilt Depression Center (734) 936-4400 ¥ Difficulty concentrating

Counseling and Psychological ¥ Feeling physically slow or Services (CAPS) having no energy (734) 764-8312 ¥ Feeling lonely even when in a University Health Services crowd (734) 764-8325 ¥ Isolating self or withdrawing U of M Psychological Clinic from others (734) 764-9190 ¥ Not caring about appearance Faculty And Staff Assistance Program (FASAP) ¥ Feeling like it’s an effort to just (734) 936-8660 get out of bed and go to class or work Sexual Assault Prevention and Awareness Center (SAPAC) ¥ Crying more than usual 24 hour Crisis Line (734) 936-3333 ¥ Acting violently towards others

Lesbian, Gay, Bi-Sexual, and ¥ Using drugs or alcohol to cope Transgender Affairs with everyday life (734) 763-4186 ¥ Mood swings International Center (734) 764-9310 ¥ Preoccupation with death

¥ Physical complaints such as aches or pains

¥ Feeling like you have the flu all the time Table of Contents

Getting Help ¥ Emergency Telephone Numbers 8 ¥ Campus Resources 9 ¥ Other Resources in the Ann Arbor Area 12 ¥ Medical Insurance 14

Definition and Treatment ¥ Depression Defined 18 ¥ Possible Causes 19 ¥ Symptoms 20 ¥ Treatments 21 ¥ Things to Discuss with Your Doctor 22 ¥ Suicide 23

Associated Issues ¥ Grief and Mourning 27 ¥ Panic Attacks and Anxiety 27 ¥ Alcohol and Drug Abuse 28 ¥ Sexuality, Sexual Health and Experimentation 30 ¥ Abuse and Violence 31 ¥ Rape and Sexual Assault 32 ¥ Self-Injury 34 ¥ Sexual Orientation 35 ¥ Eating Disorders 36

Other Resources ¥ Additional Resources 39 ¥ Suggested Reading 43 ¥ College Students and Depression: Web Resources 44 ¥ Frequently Asked Questions 45 ¥ Myths About Depression 47 “Definitely seek out help if that’s what you think you need.” Getting Help Getting Help

“I don’t want to say it’s easy from there but that’s a huge step, that first step.” Getting Help Emergency Telephone Numbers

Ann Arbor Police: 911 Front Desk: 994-2875 U-M Department of Public Safety: (734) 763-1131 U-M Psychiatric Emergency Services: (734) 996-4747 or (734) 936-6666 Department of Psychiatry: (734) 764-3471 Depression Center: (734) 936-4400 Counseling and Psychological Services (CAPS): (734) 764-8312 University Health Services: (734) 764-8325 U-M Psychological Clinic: (734) 764-9190 Faculty And Staff Assistance Program (FASAP): (734) 936-8660 Sexual Assault Prevention and Awareness Center (SAPAC) 24 hour Crisis Line: (734) 936-3333 Lesbian, Gay, Bi-Sexual, and Transgender Affairs: (734) 763-4186 International Center: (734) 764-9310

Addresses

Ann Arbor Police: 911 Front Desk: (734) 994-2875 100 N. Fifth Ave Ann Arbor, MI 48104

U-M Department of Public Safety Police Emergency Response: 911 (campus phone) or (734) 763-1131 (off-campus phone) Business Line/Dispatch: (734) 763-1331 Kipke Drive, Ann Arbor, MI 48109

U-M Hospital Emergency Services (734) 936-6666 1500 E. Medical Center Dr. Ann Arbor, MI. 48109

Washtenaw County Sheriff’s Department Police Emergency Response: 911 Detective Bureau/Criminal Investigation: (734) 971-7185 2201 Hogback Rd, Ann Arbor, MI 48105

Ypsilanti Police Department Police Emergency Response: 911 Front Desk: (734) 483-8932 505 W. Michigan, Ypsilanti, MI Campus Resources

Psychiatric Emergency Services at the University of Michigan Health System (U-M Hospital) (734) 936-5900 or (734) 936-6666 Psychiatric Emergency Services is open to the public 24 hours a day; 7 days a week. Psychiatrists and other mental health professionals provide emergency

Getting Help services to individuals, families, adults and children. Common reasons people go the Psychiatric Emergency Services are: anxiety, panic, depression, thoughts of suicide, mental illness, grief and loss issues, substance abuse, concerns about psychiatric medications, homicidal tendencies and for psychiatric hospitalization. Location: Level B1 of the Medical Center, adjacent to the Medical Emer- gency Department.

Counseling and Psychological Services (CAPS) (734) 764-8312 or (734) 763-9658 http://www.umich.edu/~caps Counseling is available to any student at the University. Counseling and Psychological Services include crisis intervention, brief personal counseling and short term psychotherapy for individuals, couples, and groups; consultation; and workshops on various informational and skill-building topics. Hours of Operation: 8:00am - 5:00pm Monday through Friday Fees: None Location 1: 3100 Michigan Union, 530 South State Street Location 2: Pierpont Commons, 2101 Bonisteel, (734) 764-8312

Psychological Clinic (734) 764-3471 http://www.umich.edu/~psychcln/ The University of Michigan Psychological Clinic provides psychological care for students and residents of Ann Arbor and neighboring communities, including University staff and faculty, graduate and undergraduate students. The Clinic has a sliding fee scale. Hours of Operation: 8:00am - 5:00pm Monday through Friday Fee: Sliding scale from $26-$100; most insurances accepted. Location: 525 E. University, Suite 2463 Getting Help Depression Center (734) 936-4400 http://www.med.umich.edu/depression/ The Depression Center is comprised of mental health providers who specialize in the treatment of depression. These professionals include psychiatrists, nurses, psychologists and social workers. Appointments: (734) 936-4400. Free Screening for Depression: (734) 763-7495 General Information: (734) 763-8430

University Health Services (UHS) (734) 764-8325 http://www.uhs.umich.edu/ UHS provides educational programs on various health issues for all students, staff, faculty at U- M. Health care services include medical clinic, gynecological exams, contraception, testing for STD’s and HIV, immuniza- tions, morning-after pill. UHS provides comprehensive outpatient medical services to students funded primarily through the Health Service fee which is included in the students’ tuition assessment each term. NOTE: The Univer- sity strongly recommends that every student be covered under a private health insurance plan. Most of these plans will cover the majority of diagnostic tests and procedures that might be performed at Health Service. The Health Service fee will cover most services provided at UHS that are not covered by a student’s private health insurance.

Any student who does not have private health insurance coverage through another source is strongly encouraged to purchase Student Group Health Insurance, which is available through the Michigan Student Assembly, at the time of registration. Hours of Operation: 8:00am - 4:30pm Monday through Friday (opens at 8:30am Spring/Summer terms); Saturday: 9:00am - 12:00pm urgent care only Location: 207 Fletcher Street

U-M Faculty and Staff Assistance Program (FASAP) (734) 936-8660 http://www.umich.edu/~fasap/ Counseling and referral services for all U-M faculty and staff. Hours of Operation: 8:00am - 5:00pm Monday through Friday Fees: None Location: 207 Fletcher, Ann Arbor, MI 48109-1432 Lesbian, Gay, Bi-Sexual, and Transgender Affairs (734) 763-4186 http://www.umich.edu/~inqueery/ Services provided include professional peer counseling, crisis intervention, referral, civil rights advocacy, community organizing, social and educational programs, consultation to student groups, coming-out groups, resource library, lounge and meeting space. Location: 3116 Michigan Union, 530 South State Street

Getting Help

Sexual Assault Prevention and Awareness Center (SAPAC) Medical Center Office: (734) 998-9368 24 hour Crisis Line: (734) 936-3333 http://www.umich.edu/~sapac This office offers education/programs on sexual assault, sexual harassment, dating and domestic violence, prevention, awareness, sexism and related issues as well as confidential counseling and crisis intervention. Location: 715 N. University, Suite 202

International Center (734) 764-9310 http://www.umich.edu/~icenter/ The International Center serves students and faculty from other countries as they adjust to a new culture. Advisors at the Center are available for help with financial, immigration, housing, and adjustment problems. New students from abroad are requested to visit the Center upon arrival for orientation. Central Campus: 603 East Madison North Campus: Pierpont Commons, 2101 Bonisteel; (734) 936-4180

William Monroe Trotter House, Multicultural Center (734) 998-7037 This office serves as the Student Multi-Ethnic Cultural Center for peer counseling which is open to all students of color. The William Monroe Trotter House, part of the Office of Multi-Ethnic Student Affairs, is the multicultural student center at the University of Michigan. Location: 1443 Washtenaw Avenue Getting Help North Campus Family Health Services (734) 647-1636 http://www.nursing.umich.edu/ncfhs/#services North Campus Family Health Service (NCFHS) is a community-based primary health center that serves all U-M students, employees, staff and their families. Care is provided by nurse practitioners and nurse midwives working collaboratively with physicians and other health care providers. NCFHAS provides a full range of primary care services. Fees: Most insurances are accepted; sliding scale is available. Location: 2364 Bishop St. FAX: (734) 763-9634

Ann Arbor Area Resources

All of the phone numbers below are area code 734

Ann Arbor Center for the Family 995-5181 Ann Arbor Mediation Center 663-1239 Ann Arbor Psychological Consultants 741-8844 Alternatives to Domestic Aggression- Ypsilanti 971-9781 Assault Crisis Center Crisis Line- Ypsilanti 971-3696 Catholic Social Services 971-9781 Center for Behavior & Medicine 677-0809 Chelsea Hospital Behavioral Health 475-6051 Chelsea Hospital Partial Hospitalization 665-5070 Counseling Center of Ann Arbor 761-7204 Domestic Violence Project 24 hour Hot Line 995-5444 Safe House Domestic Violence Project Business Office 995-5444 Family Therapy Associates 663-5955 Full Circle Community Center - Ypsilanti 485-2020 Help Source 973-2408 Huron Valley Consultation Services 662-6300 Huron Valley Child Guidance Center 971-9605 McAuley Behavioral Health Services 712-2595 Michigan Ability Partners 975-6880 Samaritan Counseling Services 677-0609 SOS Community Services 485-8730 Suicide Hot Line- Ann Arbor 996-4747 U-M Center for the Child & Family 764-9466 U-M Family Assessment Clinic 998-9700 U-M Psychiatric Emergency Services Crisis Line 936-5900 U-M Psychological Clinic 764-9190 U-M Riverview Clinic 936-0240 Washtenaw County CMH* Administration- Ypsilanti 484-6620 Washtenaw County CMH Access to Services 481-2502 Washtenaw County CMH Sub. Abuse Referral System 481-2502 Washtenaw County CMH Youth & Family Services 971-9605

Getting Help Washtenaw CMH Professional Services- Ann Arbor 971-2282

*CMH= Community Mental Health

How to Locate Mental Health Resources in Your Community

The following individuals or organizations can often provide treatment services and/ or make referrals: Family doctors Mental health providers: psychiatrists, psychologists, social workers, and counselors Your insurance provider Hospitals Family and social service agencies Employee assistance programs Private clinics University offices such as Academic Advising, Multi-Ethnic Student Affairs (MESA), International Center Staff in residence halls

Topics to look under in the yellow pages: health, mental health, social services, hospitals, hotlines, physicians, or crisis intervention services

Remember that there are others at the University of Michigan who may assist you in getting the help you need. Consider talking with staff at any of the following: Academic Advising Multi-Ethnic Student Affairs (MESA) International Center Campus ministries listed at http://www.umich.edu/~religion/directory.htm Getting Help Medical Insurance

Keep in mind that insurance policies have different benefits. Some fully cover mental health and counseling, some limit the number of therapy sessions and require a co-pay, and others do not provide any coverage. Confidentiality is a part of all therapy and counseling appointments, but medical insurance companies can request copies of the therapists’ notes if they are paying for such visits.

Your best source of information about your specific insurance coverage is the insurance company that issued your policy. You also might ask your parents or your employer. In all cases, you, not your insurer, are the “responsible party” for all payment for medical services. Even though you have health insurance, it is your responsibility (or that of your parents) to make sure that your medical bills are paid.

Call your insurance company to determine your mental health benefits before scheduling an appointment. Your insurance company may require you to obtain prior authorization before your benefit can be used. The University of Michigan is not a participating provider for all insurances. Therefore, your insurance may not pay for University sponsored services. When talking to your insurance carrier or employee benefits department, be sure to ask the extent of your mental health benefit available. You will be held responsible for all deductibles and co-payments associated with your benefit, as well as any portion of your bill not covered by insurance.

The places on campus that have a limited number of free counseling sessions for all students, faculty and staff are: Counseling and Psychological Services Sexual Assault Prevention and Awareness Center The International Center

Remember, too, that paperwork and questionnaires are a necessary part of receiving treatment. The counselor or health care provider needs to know about you in order to provide appropriate treatment. “I guess a lot of the motivation to seek treatment again came from knowing other people that were dealing with depression.” Definition and Treatment Definition and Treatment

“…doing nothing won’t do any good….And so I think you have to take a practical approach and say, ‘Whatever works.’ That means, don’t stop until it works.” Definition and Treatment Defining Depression

Depression is a serious medical condition and it is treatable!

According to the National Institute of Mental Health, this illness can take three forms:

¥ Major depressive disorder (also known as major depression) ¥ Dysthymic disorder ¥ Bi-polar disorder

Major depressive disorder is diagnosed when an individual has five or more of the following symptoms and impairment of daily functioning exists for more than two weeks:

¥ Sad mood ¥ Loss of interest in pleasurable activities ¥ Energy loss ¥ Physical slowing or agitation ¥ Change in appetite or weight ¥ Difficulty sleeping or oversleeping ¥ Feelings of worthlessness or inappropriate guilt ¥ Difficulty concentrating or thinking ¥ Recurrent thoughts of death or suicide

Dysthymic disorder is when a person has at least two of the above symptoms of depression and their depressed mood persists for at least 2 years.

Bi-polar depression is characterized by bouts of both depression and mania. Mania is characterized by abnormal “highs” or elevated mood, irritability, racing thoughts, decreased need for sleep, excessive risk taking, overly inflated self-esteem, physical agitation, distractibility, increased talkativeness and often increased use of alcohol and other drugs. Possible Causes

These are the risk factors involved in major depression: ¥ Age - The most common age of onset for depression is 15-24. ¥ Gender - Females are twice as likely as males to become depressed. ¥ Marital status - Single individuals are more likely to become depressed. ¥ Previous episode(s) - Individuals who have had at least one episode of depression are at greater risk to experience a second bout of depression. ¥ Heredity- Individuals are more likely to become depressed if depression is present in their immediate family.

It is important to remember that there is no one cause of depression. Depression is often caused by a variety of factors, including: ¥ Repressed anger ¥ Anxiety

Definition and Treatment ¥ Trauma ¥ Psychological stress and life events ¥ Substance abuse ¥ Hormones ¥ Biological and genetic factors ¥ Environmental influences ¥ Childhood or developmental events ¥ Losing a loved one ¥ Chronic illness ¥ Family influences ¥ Behavioral influences ¥ Cognitive influences (negative beliefs about self/biases toward others)

A complex relationship exists among stressful situations, our mental and physical reactions to stress, and the onset of depression. It is clear that some people develop depression after a stressful event in their lives. College students also may experience depression in response to: ¥ Academic difficulties ¥ Health problems or illness ¥ Major life changes (moving, roommate difficulty, etc.) ¥ Homesickness and feelings of loneliness ¥ Substance use including alcohol ¥ Eating disorders ¥ Rape or violence within a relationship ¥ Sexuality issues ¥ Poor social relationships ¥ Family issues Definition and Treatment Symptoms of Depression

¥ Sad mood

¥ Loss of interest or pleasure in activities

¥ Change in weight or appetite

¥ Difficulty sleeping or sleeping too much

¥ Agitation and/or irritability

¥ Recurrent thoughts of suicide

¥ Feelings of worthlessness or inappropriate guilt

¥ Difficulty concentrating

¥ Feeling physically slow or having no energy

¥ Feeling lonely even when in a crowd

¥ Isolating self or withdrawing from others

¥ Not caring about appearance

¥ Feeling like it’s an effort to just get out of bed and go to class or work

¥ Crying more than usual

¥ Acting violently towards others

¥ Using drugs or alcohol to cope with everyday life

¥ Mood swings

¥ Preoccupation with death

¥ Physical complaints such as aches or pains

¥ Feeling like you have the flu all the time Treatments

In the United States today there are many types of treatment for depression. The most common treatments are psychotherapy, antidepressant medications, and the combination of these two.

The field of psychotherapy has changed radically over the past twenty years. Many new advancements and research have increased the effective- ness of treatments. The most common types of psychotherapy that are useful in the treatment of depression are Cognitive Behavioral Therapy (CBT) and Interpersonal Therapy (IPT).

Research shows that antidepressant medications are widely used and are an effective treatment for depression. These medications influence the functioning of certain chemicals in the brain called neurotransmitters.

Definition and Treatment Often, when a person becomes depressed, they experience abnormalities in neurotransmission. Neurotransmission is how the brain receives and sends brain chemicals. The common neurotransmitters which are implicated in depression include norepinephrine, serotonin and neuropeptide.

Today, selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat depression because they have the fewest number of side effects than other drugs.

When discussing antidepressants with the psychiatrist or primary doctor who is prescribing medication, be sure to ask about the side effects of that drug and always tell the doctor about any other medications you are taking. Any type of drug, including over-the-counter drugs and street drugs, can cause harmful side effects if taken with antidepressants. Definition and Treatment Things to Discuss with Your Doctor

¥ Any thoughts of hurting yourself or others ¥ Any change in sleep patterns ¥ If you are crying a lot ¥ Any changes in your eating patterns ¥ If you feel like you just want to be alone all the time ¥ If you have felt like this before ¥ If you have a parent or relative who suffers from depression (even if it is not diagnosed) ¥ If you are having trouble performing daily tasks like going to class or work ¥ If you feel tired all the time ¥ Any concerns you have about taking medications ¥ What the side effects could be ¥ Mention any other drugs you are taking ¥ Ask about drinking alcohol while on the medication ¥ Any concerns you have about how long it take to feel better

Don’t be afraid to ask your doctor anything even if the answer seems obvious or you are worried that you might look bad. Suicide

Suicide is the third leading cause of death for youths 15 to 24 years old. College aged individuals sometimes experience strong feelings of stress, self-doubt, loneliness, isolation, confusion, grief, academic pressure and social distress. These pressures can lead to bouts of depression and even suicide attempts. Often, people who are considering suicide do not want to die; they just want their pain to go away. Remem- ber that depression and suicidal feelings are treatable and there is help.

According to the American Psychological Association, common warning signs include:

¥ A previous suicide attempt

Definition and Treatment ¥ Isolating or withdrawing from friends, family, regular activities and peer groups ¥ Current talk of suicide, or making a plans for suicide ¥ A strong wish to die and/or preoccupation with death ¥ Violent actions and reactions to others or self ¥ Giving away prized possessions ¥ Signs of serious depression, such as hopelessness and withdrawal ¥ Increased alcohol and/or other drug use ¥ Unusual neglect of personal appearance ¥ Marked personality change ¥ Recent suicide attempt by a friend or family member ¥ Readily accessible firearms, medications, and other potentially harmful materials ¥ Impulsiveness and taking unnecessary risks ¥ Lack of social support and connection with family and friends (no one to talk to) ¥ Difficulty concentrating, overwhelming boredom ¥ Decline in quality of academic work ¥ Frequent physical complaints such as body aches and headaches ¥ Inability to accept or acknowledge praise or compliments ¥ Feeling “rotten inside” ¥ Verbal cues (“nothing matters” or “I won’t see you after this”) Definition and Treatment There is no typical suicide victim.

Always take stated intentions of suicide seriously. Do not avoid talking about the subject. For someone thinking of suicide, it actually can be a relief to talk about it. If you think someone you know is contemplating suicide, you might begin a conversation by saying:

¥ Can you tell me what is going on and why you are in such pain? ¥ Are you thinking about killing yourself? ¥ I would really like to help you through this hard time. ¥ I don’t want you to kill yourself.

If you are concerned that someone is at risk for suicide, get help immediately.

National Hopeline Network: 1-800-SUICIDE (1-800-784-2433)

National Crisis Line: 1-866-334-HELP (1-866-4357)

American Association of Suicidology 4201 Connecticut Avenue, NW, Suite 408 Washington, DC 20008 (202) 237-2280 or 1-800-SUICIDE (784-2433)

“But I feel more confident now, knowing that I know what the signs are.” “I think it’s not always a life issue or a chemical issue or a biological thing going on in your brain. Sometimes there’s a darned good reason to be depressed.” Associated Issues Grief and Mourning

Grief is often experienced in four major ways: psychologically, behavior- ally, socially, and physically. Grief is not a static state of being and often continues throughout development. It is a natural, expected reaction to both loss and death. Each person responds differently to grief and it is dependent on an individual’s unique perception of loss.

People also may experience Subsequent Temporary Upsurges of Grief (STUG) at different times throughout their life. STUGs can occur in

Associated Issues response to a death or loss of an important figure in one’s life. Individu- als who experience this are not necessarily depressed. Most of us will experience this in the course of a lifetime.

If you are not sure whether or not what you are experiencing a STUG or a more serious depression, consult a mental health care provider for help in deciding if additional treatment is needed.

Panic Attacks and Anxiety

Panic attacks can be a response to anxiety and are one of the most common mental disorders, affecting 3-5% of the population. These attacks may occur “out of the blue” or in response to fear, realistic or not. They usually last only seconds or minutes, but their effects may last for hours.

Some common symptoms of anxiety are:

¥ Often feeling tired even though you have had a good night’s sleep ¥ Your heart seems to race out of control ¥ Insomnia ¥ Bouts of backache that hit for no apparent reason ¥ Indigestion, diarrhea, or headache are frequently keeping you from functioning at your best ¥ Hyperventilating Associated Issues ¥ Noticing that certain situations make you feel extremely nervous ¥ Feeling like you are falling to pieces or going crazy

What causes this? Some people have a chemical imbalance that predisposes them to feeling anxious. Others cannot cope with stress in a constructive way. Those who suffer anxiety and panic attacks are not mentally ill, but if the fear is irrational and inhibits normal, everyday activities, they may have a phobia.

The good news is that anxiety and panic attacks are considered to be the most treatable of all psychiatric conditions. Effective treatment might include cognitive-behavioral therapy and/or medication. Talk to your primary care provider, therapist, or doctor about what can be done to treat these attacks.

Anxiety Disorders Information 1-888-826-9439 (1-888-88-ANXIETY)

Anxiety Disorders Association of America (301) 231-9350

Alcohol and Drug Abuse

For many students college life is a time to experiment with drug and alcohol use. Often when people feel depressed, they try to improve their moods through the use of alcohol and/or drugs. Unfortunately, what they do not realize is that using drugs of any type, including alcohol, can make depression worse. Excessive alcohol or drug use can lead to depression. It often becomes a cyclical pattern in which cause and effect cannot be distinguished.

Some students try to relieve stress by socializing, partying, and through other drug use. According to the National Institute on Drug Abuse, marijuana use can cause depressed moods, memory problems, difficulty in thinking and problem solving, distorted perceptions, loss of coordination, increased heart rate, anxiety, and panic attacks. In a study of college students, it was shown that long term marijuana use impairs skills related to attention, memory, and learning.

Drugs such as ecstasy, methamphetamines, and “date rape drugs” (GHB, rohypnol, and ketamine) are found with increasing frequency. Ecstasy use can actually lead to the loss of brain cells that regulate sleep, mood, and memory, thus increasing depression or the symptoms of depression. Methamphetamine (“speed,” “chalk,” “ice”) can cause increased agitation, decrease in appetite and increased energy levels in the short term. In long- term users, it can cause an increase in aggression levels, depression and other health problems such as memory loss, or potential cardiac and neurological damage. The use of any of these drugs can cause a person to become more depressed and can be dangerous when mixed with alcohol.

These are common signs that someone may have a drinking or drug problem:

¥ Neglected appearance or hygiene ¥ Poor self-image and low self-esteem

Associated Issues ¥ Academic performance suffers ¥ Slurred speech ¥ Skin abrasions ¥ No concern for the future ¥ Violent outbursts at friends and peers ¥ Reckless behavior ¥ Defiling personal belongings ¥ Stealing or borrowing money ¥ Changing friends ¥ Lying and deception ¥ Disrespectful to those around them ¥ Disregarding the consequences of their actions ¥ Depressed mood ¥ Inconsistent mood swings ¥ Apathy ¥ Isolation or withdrawal ¥ Frequent use of eye wash ¥ Unexplained weight drop ¥ Possession of drug paraphernalia ¥ Glassy and/or red eyes ¥ Truancy ¥ Lack of motivation ¥ Verbally abusive to others ¥ Manipulative towards others

Alcoholics Anonymous 1-800-711-6375 12 step support program. Call for information and locations.

Al-Anon District 5 (Ann Arbor) Answering service: (734) 995-4949 Meeting info in U.S. and Canada (8:00am - 6:00pm ET, M-F): 1-800-4AL-ANON Alano Club of Washtenaw 995 N Maple Rd Ann Arbor, MI 48103 (734) 668-8138 Meetings of Alcoholics Anonymous, Al-Anon, Adult Children of Alcoholics

Chelsea Arbor Outpatient Services (734) 930-0201 955 W. Eisenhower, Suite 102, Ann Arbor, MI 48103 Fees: Private pay, insurance, and sliding fee.

Dawn Farm (734) 485-8725 P.O. Box 98198, Ypsilanti, Michigan 48197 Fees: $50/day; some financial assistance available

Substance Abuse and Mental Health Administration Substance Abuse Treatment Facility Locator http://findtreatment.samhsa.gov/facilitylocatordoc.htm

Sexuality, Sexual Health and Experimentation

Sexual experimentation often occurs during the college years. According to current research:

¥ About 55% of 17 year olds have had sex ¥ About 80% of 19 year olds have had sex ¥ About 20% of young people do not have sex while teens

The term sex has many definitions and meanings. Sex does not necessarily mean intercourse. It can include a spectrum of behaviors. Sexuality, sexual pressures and choices can be a source of confusion and even depression in our lives.

For many, the years between ages 17 to 24 represent a time of new-found independence, marked by new and sometimes difficult decisions. Difficulty with making decisions can sometimes lead to depression. If you find that you or a friend are feeling troubled about sexual behavior, sexuality and/or sexual health concerns such as sexually transmissible diseases, talk to someone! Other stressful situations may be involved.

Sharing your concerns with a health care provider, resident advisor, or other trusted staff member might provide the assistance you need.

University Health Services (UHS) 207 Fletcher Street Ann Arbor, MI 48109 (734) 764-8325 http://www.uhs.umich.edu/

Associated Issues Planned Parenthood Location 1: 3100 Professional Dr. Ann Arbor, MI. 48106 (734) 973-0710 Location 2: 840 Maus Ave., Ypsilanti, MI. 48198 (734) 485-0144 Hours: Monday-Friday 8:30am - 8:00pm, Sat 8:30am - 4:00pm Fees: Sliding scale

Center for Disease Control (CDC) National STD Hotline 1-800-227-8922

American Social Health Association P.O. Box 13827, Research Triangle Park, NC 27709

Abuse and Violence

Abuse and violence in relationships (also known as domestic violence or partner violence) are a pattern of behavior used by adults and adolescents to control their intimate partners. Such behaviors include:

¥ Sexual abuse or assaults ¥ Physical abuse, including hitting, pulling hair and pinching ¥ Verbal abuse, including name calling and swearing ¥ Emotional abuse ¥ Economic control ¥ Destruction of pet or property Associated Issues Abuse is not rare. More than 2.5 million women experience some form of violence each year, and a relative or someone they know attacks nearly two out of every three of these women. One in four women will be attacked during her college career. However, men as well as women are victims of abuse and violence. If your partner is hurting you, there is no reason for shame, guilt or secrecy. Remember, violence is a crime regardless of any relationship involved.

On the University of Michigan campus and in the surrounding community there are offices and agencies dedicated to helping people in abusive and violent situations. Staff are respectful of individual circumstances and choices, and will assist in whatever way possible.

U-M Sexual Assault Prevention And Counseling (SAPAC) 715 N. University, Suite 202 Business: (734) 998-9368 Crisis: (734) 936-3333

Domestic Violence Project, Inc./SAFE House P.O. Box 7052 Ann Arbor, MI 48107 Crisis: (734) 995-5444 (734) 973-2227 TTY

For services outside of Washtenaw County, call: 1-800-799-SAFE 1-800-787-3224 TTY

Rape and Sexual Assault

Rape occurs when one person subjects another to unwanted sexual intercourse, oral sex, anal sex, or other sexual contact through force or threat of force. Reports indicate that between 50 and 70 percent of all rapes occur within the context of a romantic relationship.

Some of the common consequences of rape for the victim include withdrawal, eating disorders, depression, anxiety, problems in relationships and sexual dysfunction. Many victims of rape suffer from Post-Traumatic Stress Disorder (PTSD), a complicated psychological condition. Those that suffer PTSD may find themselves involuntarily reliving the traumatic experience, hyper-vigilant for any sign of future threat, unable to concentrate at work or school, unable to enjoy previous enjoyable activities, unable to sleep, etc. The consequences of rape may require medical or psychological intervention and usually require a lengthy period of time to heal.

What may make healing more difficult for survivors of acquaintance rape is the failure of therapists, friends, and loved ones to recognize that the emotional impact of rape is just as serious when the victim knew the attacker (if not more so). The victim of an acquaintance rape not only

Associated Issues suffers all of the same humiliation, pain, loss of personal integrity and security that any rape victim suffers, but also suffers the betrayal of the relationship by the attacker and questions his or her own judgment and ability to protect himself or herself. The victim may also suffer blame from others.

If you or someone you know has been raped or sexually assaulted, it is important to get help immediately. Call the emergency numbers listed in the front of this guide, or contact:

U-M Sexual Assault Prevention No Means No and Counseling (SAPAC) Crisis: 1-877-666-3267 715 N. University, Suite 202 Michigan statewide sexual assault Business: (734) 998-9368 hotline. Provides one-time crisis Crisis: (734) 936-3333 intervention, support, and referral.

Assault Crisis Center Rape, Abuse, Incest National Crisis: (734) 971-3696 (7273) Network 2940 Ellsworth Rd. Crisis: 1-800-656-4673 Ann Arbor, MI 48197 Provides crisis intervention, support and referrals. Associated Issues Self-Injury

The practice of physically abusing one’s own body is known by a number of terms: self-mutilation, self-harm, SI, or usually just as cutting. This includes a range of destructive behaviors. While cutting with any sharp or jagged object is most common, self-injury also takes the form of burning, wound interference and picking, hitting, hair-pulling, even breaking bones. Cutting usually begins during puberty and lasts 5 to 10 years, but it can go on much longer if left untreated. People often will cut themselves on the arms or legs because it is easier to hide the wounds with clothing.

Generally, cutting is not an attempted suicide. Instead it is a means of coping with painful feelings. Self injury is found in those with feelings of guilt, helplessness, rejection, self-hatred, anger, failure and loneliness. Cutting can occur for many reasons. For some people, cutting enables them to feel better by allowing them to express their emotions physically. For these people the cutting temporarily relieves their stress and anxiety. Often - although not always - these feelings stem from past or present influential events (e.g., domestic violence, divorce of parents, death of loved ones, sexual abuse, alcoholism, etc.).

Here is the vicious cycle of cutting. The act makes the person feel powerful, in control, and alive. Then they quickly feel guilty and ashamed for having cut themselves. This makes them anxious and sets the stage for more cutting.

Many self injurers find it extremely difficult to express their reasons for self injury to any specific level, which is why counseling and therapy can be so beneficial to self injurers.

Dangers of Cutting

¥ misjudging the depth of a cut so that stitches are required (or, in extreme cases, hospitalization) ¥ infection ¥ risk of spreading illness (such as HIV or hepatitis) if two people share a cutting tool Sexual Orientation

College is often a time that people question their sexuality. Being bisexual, lesbian, or gay is typically not discussed or expected in our society. It is a topic that many people feel uncomfortable discussing. Yet considerations of sexuality are a part of every day life on college campuses.

The phrase “coming out” refers to the process in which a lesbian, gay man, or bisexual person comes to accept their sexual orientation and share their experiences with others in their lives. Sometimes that process is relatively

Associated Issues quick, other times it takes years. In many ways, a GLB (Gay/Lesbian/ Bisexual) person will go through many “coming out” experiences throughout his or her lifetime. Race, ethnicity, gender, culture, age, ability status, class, faith and other social characteristics often influence one’s reaction to the topic of sexual orientation.

It is important that people questioning their sexuality know that it is a part of human development and there is nothing wrong with them for doing so. For some, questioning one’s sexuality can often be a time of loneliness and depression. Support exists to help a person through the questioning and/ or coming out process.

U-M Office of LGBT Affairs Crisis Lines for Lesbian, Gay, 3200 Michigan Union Bisexual and Transgender Affairs 530 S. State Trevor Hotline Ann Arbor MI 48109-1349 1-800-850-8078 734-763-4186. (based in California)

The Oasis: Lesbian, Gay, Bisexual, Affirmations Transgender (LGBT) Ministry Crisis Counseling: St. Andrew’s Episcopal Church 1-800-398-4297 (after 4:00pm) 306 N. Division St. Business Line: (248) 398-7105 Ann Arbor, MI 48104 Ferndale, MI (734) 930-0056 Associated Issues Eating Disorders

During the college years, many people feel pressures to be thin. This desire for thinness can become detrimental to one’s health. What often begins as a diet to increase self-esteem can turn emotionally harmful and even dangerous. Current research shows that between 20 and 35 percent of all college students, both male and female, will struggle with one type of dysfunctional eating habit or disorder.

The two most prevalent eating problems on campuses in the United States are anorexia nervosa and bulimia. Anorexia nervosa is characterized by an individual’s desire for thinness which leads to voluntary starvation. People with anorexia nervosa usually appear unhealthy and overly thin. Bulimia, also known as the binge/purge syndrome, is characterized by the desire to eat to the point of being overly full and then vomiting to expurge the food before it has a chance to be digested. People with bulimia often appear to maintain a healthy weight range and may be difficult to identify. People can suffer from both anorexia and bulimia at different times in their lives.

Warning signs for these disorders include:

¥ Abnormal weight loss without a reason or medical illness ¥ Excessive exercising despite feeling exhausted or weak ¥ Obsessions with counting calories ¥ Fear of being fat or gaining weight ¥ Sharp reduction in food intake ¥ Denying feelings of hunger to maintain or decrease weight ¥ Rituals or patterns of handling food that appear odd or peculiar ¥ Loss of menstrual period in women (amenorrhea) ¥ Bingeing and purging behaviors ¥ Inconsistent eating patterns such as fasting then bingeing ¥ Depressive moods or mood swings ¥ Hiding food or hoarding food University Health Services (734) 764-8325 Psychiatric Emergency Services (734) 936-5900 Depression Center (734) 936-4400 Counseling and Psychological Services (CAPS) (734) 764-8312 Psychological Clinic (734) 764-3471

Center for Eating Disorders 111 N. First St. #2 Ann Arbor, MI 48104 (734) 668-8585 Fees: Call for fees

Associated Issues Support groups, including Anorexia/Bulimia Support Groups, Compulsive Eating Support Groups; individual counseling; outreach.

Overeaters Anonymous Contact Martha, (734) 480-4556 Open “Newcomers Meeting” Mondays 7:30 pm Church of the Good Shepherd 2145 Independence Boulevard Ann Arbor. MI (Do not have to call in advance)

The Therapy Center of Ann Arbor 111 N. First St. Ann Arbor, MI 48104 (734) 668-8448

Bulimia, Anorexia Self Help/Behavior Adaptation Support and Healing 1-800-762-3334, 1-800-227-4785

National Eating Disorders Association 603 Stewart St., Suite 803 Seattle, WA 98101 (206) 382-3587 http://www.nationaleatingdisorders.org Other Resources Additional Resources

Culturally Specific Service Providers

Arab American and Chaldean Council (248) 559-1990 http://www.arabacc.org/

Other Resources Arab Community Center for Economic and Social Services (ACCESS) (313) 843-2844 http://www.accesscommunity.org

Community Center for Economic and Social Services (313) 843-2844

Black Family Development (313) 272-3500 http://www.blackfamilydevelopment.org/

Jewish Family Services (248) 559-1500 http://www.hvcn.org/info/jewish/

Latin Americans for Social and Economic Development (LA SED) (313) 554-2025

Latino Family Services, Inc. (313) 841-7380 http://comnet.org/local/orgs/latino/

Depression

American Psychological Association 750 First Street, NE Washington, DC 20002-4242 (202) 336-5510 or 1-800-374-2721 http://www.apa.org/ Other Resources Depression and Related Affective Disorders Association (DRADA) 600 N. Wolfe Street Baltimore, MD 21287-7381 (410) 955-4647 (Baltimore); (202) 995-5800 (Washington, DC) e-mail: [email protected] http://www.drada.org

Depression Awareness, Recognition, and Treatment Program 1-800-421-4211

Doctor Directory.com Find Psychiatrists in Michigan by City http://www.doctordirectory.com/Doctors/Directory/

Find-a-Therapist.com Find Mental Health Therapists in Michigan http://www.findingstone.com/find-a-therapist/regions/usa/MI.htm

Michigan Mental Health Networker Referral Resources for Lansing Area, Macomb County, Mid-Michigan (Flint/Bay City/Midland/Saginaw), Oakland County, Washtenaw County, and Wayne County http://www.mhweb.org/

National Alliance for the Mentally Ill (NAMI) Colonial Place Three 2107 Wilson Blvd., Suite 300 Arlington, VA 22201 (703) 524-7600 or 1-800-950-NAMI http://www.nami.org

National Depressive and Manic Depressive Association 730 North Franklin Street, Suite 501 Chicago, IL 60610-3526 (312) 642-0049 or 1-800-826-3632 e-mail: [email protected] http://www.ndmda.org

National Empowerment Center 1-800-769-3728 http://www.power2u.org/ National Foundation for Depressive Illness P.O. Box 2257, New York, NY 10116 1-800- 239-1265 http://www.depression.org

National Institute of Mental Health Information Resources and Inquiries Branch 6001 Executive Boulevard, Room 8184, MSC 9663 Bethesda, MD 20892-9663 (301) 443-4513 fax: (301) 443-4279 free brochures: 1-800-421-4211

Other Resources e-mail: [email protected] http://www.nimh.nih.gov/

National Mental Health Association Information Center (703) 684-7722 http://www.nmha.org/

National Mental Health Consumers' Self-help Clearinghouse (215) 751-1810 http://www.mhselfhelp.org/

Obsessive-Compulsive Foundation (203) 315-2190 http://www.ocfoundation.org/

HIV and AIDS

HIV/AIDS Resource Center (HARC) 3075 Clark Rd., Ste. 203, Ypsilanti, MI 48197 (734) 572-9355

Michigan AIDS Hotline 1-800-872-AIDS (2437) Telecommunication Device for the Deaf (TDD): 1-800-649-3777 Spanish language hotline: 1-800-344-SIDA (7432)

Center for Disease Control (CDC) National AIDS Hotline 24-Hour Crisis Line: 1-800-342-2437 Other Resources Religious Resources http://www.umich.edu/~religion/directory.htm

Sexual Health, STD’s and Contraception

Planned Parenthood Location 1: 3100 Professional Dr. Ann Arbor, MI. 48106 (734) 973-0710 Location 2: 840 Maus Ave., Ypsilanti, MI. 48198 (734) 485-0144 Hours: Monday-Friday 8:30am - 8:00pm, Sat 8:30am - 4:00pm Fees: Sliding scale

Center for Disease Control (CDC) National STD Hotline 1-800-227-8922

Women’s Resources

Women’s Health Resource and Education Center at U-M Hospital 1324 Taubman Center (734) 936-8886 Resource for questions about women's health issues. Suggested Reading

Burns, D. (1999). Feeling Good: The New Mood Therapy.

Copeland, M. E. (1994). Living without Depression and Manic- Depression: A Workbook for Maintaining Mood Stability.

Jamison, K.R. (1999). Night Falls Fast: Understanding Suicide.

Other Resources Gorman, J. (1998). Essential Guide to Psychiatric Drugs.

Jamison, K. R. (1997). An Unquiet Mind: A Memoir of Moods and Madness.

Jamison, K.R. (1996). Touched with Fire: Manic-Depressive Illness and the Artistic Temperament.

Klein, D. & Wender, P. (1994). Understanding Depression: A Complete Guide to Its Diagnosis and Treatment.

Mondimore, F. M. (1999). Bipolar Disorder: A Guide for Patients and Families.

Mondimore, F. M. (1993). Depression: the Mood Disease.

Reid-Wilson, R. (1996). Don’t Panic. Harper Perennial, Harper Collins: New York.

Solomon, A. (2001). The Noonday Demon: An Atlas of Depression.

Styron, W. (1992). Darkness Visible: A Memoir of Madness. Other Resources College Students and Depression: Web Resources

American College Counseling Association http://www.collegecounseling.org

American College Health Association http://www.acha.org

American College Personnel Association http://www.acpa.nche.edu

American Foundation for Suicide Prevention http://www.afsp.org

Anxiety Disorders Association of America http://www.adaa.org

CampusBlues http://www.campusblues.com

Eating Disorders Awareness and Prevention, Inc. http://www.nationaleatingdisorders.org

National Clearinghouse for Alcohol and Drug Information http://www.health.org

National Institute of Mental Health http://www.nimh.nih.gov

National Panhellenic Conference http://www.npcwomen.org

Psychology Information Online http://www.psychologyinfo.com/depression/index.html

The BACCHUS and GAMMA Peer Education Network http://www.bacchusgamma.org Frequently Asked Questions

Depression is uncommon in people my age. Why am I so alone? You may feel that you are alone in your depression, but each year, 10 million people in the United States suffer from depression. Most cases of depression are diagnosed between the ages of 15 and 50. Some studies show that 1 out of 3 college students will experience some form of depression during college. You are not alone. There is help.

What can I do to help a friend who is depressed? Other Resources When you suspect friends are depressed, ask them how they are feeling and then listen. You may be the first person they open up to. Encourage them. Tell them that there is help and they can feel better. Let them know that you are worried about them and have noticed the changes they are going through. Remain as calm as possible and don’t blame them for how they are feeling. Let them know you care and are willing to help.

My doctor recommended I go to therapy. Why is this necessary? Psychotherapy is an important step in treating depression. It allows you to talk to someone about how you are feeling and begin to understand why you are feeling this way. Research has shown that people who take medication and participate in therapy respond better than choosing one or the other forms of treatment.

Every year around winter I begin to feel less energetic and blue. Could I be depressed? It is possible that you are suffering from Seasonal Affective Disorder (SAD). SAD is a cyclical type of depression usually experienced in the fall and winter months. For most SAD sufferers, the lack of sufficient light seems to effect their mood and causes them to become depressed. Treat- ments for SAD include light therapy, medication, and psychotherapy, much like other forms of depression. Increasing your exercise or activity level can help. If you feel you suffer from SAD, talk to your primary care provider about what you can do to treat this condition.

I think a friend has an eating disorder. What can I do to help? Don’t be afraid to talk to your friend about your concerns. Some possible suggestions are:

1. Take note of the behaviors and talk to someone you trust about the warning signs and your concerns for that person. 2. Let your friend know, in a non-judgmental way, that you have noticed the irregular eating patterns and are worried about them. Other Resources 3. Provide your friend with information and resources about eating disorders. 4. Encourage your friend to talk to a professional, and help to locate resources. 5. Listen and do not judge your friend’s feelings. Validate them and don’t try to force a change in behavior without help.

I have been taking medication for four months and I feel better. Can I stop taking it? Just because you are feeling better does not mean you should stop taking the medication. Treating depression is not like taking an antibiotic for an infection. You will need to stay on the medication for a while. Talk to the doctor or psychiatrist who prescribed the medication about how long you should take it and whether or not you can stop it.

My friend is taking St. John’s Wart for depression. It is effective? Current research does not support the claim that St. John’s Wart is an effective treatment for major depression. Though many Americans take it, they may not realize that it is not approved for use by the FDA. Therefore, there is no way to tell how much St. John’s Wart to take to feel better. You should never take antidepressants and St. John’s Wart at the same time. They often can counteract one another and cause you to have unpleasant side effects.

When I feel depressed, sometimes I drink to feel better. Can alcohol or drugs help me deal with my depression? Although some people feel that drinking or taking drugs can help them feel better, it is only temporary, and can actually make depression worse. Antidepressants should not be mixed with alcohol.

I have read through the resource guide and the descriptions of depression. I don’t feel I fit into any of the categories mentioned. Is there something I can do? Not all people fit into the categories mentioned in this guide. Depression comes in different forms, and so does treatment. You can find help for how you are feeling. Talk to your doctor or primary care provider about how you are feeling, or contact some of the resources listed in this guide. Myths About Depression

Myth: It’s normal for teenagers to be moody and teens don’t suffer from “real” depression.

Fact: Depression is more than just being moody. It effects people at any age, including teenagers. You can “snap out of it”

Myth: Telling an adult that a friend might be depressed is betraying a trust. If someone wants help, he or she will get it.

Fact: Depression, which saps energy and self-esteem, interferes with a person’s ability or desire to get help. It is an act of true friendship to share your concerns with an adult who can help. No matter what you promised to keep secret, your friend’s life is more important than a promise. Myth: Prozac cures depression.

Fact: Prozac and other SSRIs control the symptoms of depression. They help a person control their symptoms and begin to feel better. Depression is a chronic illness for which there is no permanent cure. Through proper treatment, you can learn how to manage your depression and become aware of your own personal triggers and symptoms.

Your problems are making you depressed.

Myth: Talking about depression only makes it worse.

Fact: Talking about your feelings to someone who can help, like a psychologist, is the first step towards beating depression. Talking to a close friend also can provide you with the support and encouragement you need to talk to your parents or school counselor about getting evaluated for depression. Myth: People who are depressed lose interest in food, stop eating and lose weight.

Fact: People who are depressed experience symptoms in different ways. The key symptom is a change in normal diet or sleep patterns, not a specific decrease or increase in either.

You could make yourself feel better if you wanted to.

Myth: Depressed people make bad or undependable students, friends and employees.

Fact: Most people undergoing treatment for depression are able to control their symptoms. Depression can cause people to become less sociable, but it does not mean that you are incompetent or undependable. Myth: People who get depressed have serious character flaws.

Fact: Depression occurs in over 20 million Americans each year. Depres- sion does not mean you have any type of character flaw!

It’s “all in your head” Acknowledgments

Written by Elizabeth A. Bruce, MSW and Pat McCune

Research by Elizabeth A. Bruce, MSW with assistance from Bonnie Haggerty, PhD, RN, CS and Sarah Newlin, MPH

Edited and designed by Elyse Rubin

Funding provided Earl Lewis Vice Provost for Academic Affairs - Graduate Studies and Dean of the Rackham Graduate School.

This guide is part of a video documentary project, The View from Here: Depression on College Campuses, a production of Dialogues on Diversity at the University of Michigan.

For information about the video go to www.dialogues.umich.edu or call (734)615-1291

For additional copies of this guide contact

The Division of Student Affairs 6015 Fleming Administration Building 1340 (734) 764-5132

Dialogues on Diversity 1004 Rackham Building 1070 (734) 615-1291